nebulizers and vaporizers

GUIDELINE TITLE Global Strategy for Asthma Management
and Prevention (GINA Strategy Report)
RELEASE DATE April 26, 2021
PRIOR VERSION April 3, 2020
DEVELOPER AND FUNDING SOURCE The Global Initiative for
Asthma (GINA)
TARGET POPULATION Patients aged 12 y with asthma
MAJOR RECOMMENDATIONS
• Short-acting β-agonist (SABA) monotherapy is no longer
recommended (level of evidence: A).
• There is no distinction between mild-intermittent
and mild-persistent asthma; inhaled corticosteroid
(ICS)–containing therapies are recommended for
both. ICS-formoterol is recommended as the preferred
reliever inhaler (level of evidence: A).
• For treatment of moderate asthma, GINA recommends
ICS-formoterol maintenance and reliever therapy in
the preferred track (level of evidence: A).

Author/s:

Gray, S. E., Cife, A. S., Press, V. G.

Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease

Saige Blanchard — Mon, 03 Jan 2022 06:00:00 +0000

Date Added:

January 3, 2022

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier

Publication Date:

June 25, 2021

Issue:

Volume:

Pages:

2448-2463

URL:

Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2021.03.016

Keywords

Small Airways Disease

chronic obstructive pulmonary disease

copd

PMID (1):

34183115

MeSH

Humans

Drug Compounding

pulmonary disease, chronic obstructive

Spirometry

nebulizers and vaporizers

A summary of what we know about the role of small airway disfunction in COPD and its implications for evaluation and treatment. James W. Mold, MD, MPH

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For more than 50 years, small airways disease has been considered a key feature of chronic obstructive pulmonary disease (COPD) and a major cause of airway obstruction. Both preventable and treatable, small airways disease has important clinical consequences if left unchecked. Small airways disease is associated with poor spirometry results, increased lung hyperinflation, and poor health status, making the small airways an important treatment target in COPD. The early detection of small airways disease remains the key barrier; if detected early, treatments designed to target small airways may help reduce symptoms and allow patients to maintain their activities. Studies are needed to evaluate the possible role of new drugs and novel drug formulations, inhalers, and inhalation devices for treating small airways disease. These developments will help to improve our management of small airways disease in patients with COPD.

Author/s:

Usmani, O., Dhand, R., Lavorini, F., Price, D.

Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma

Tracy Ashby — Thu, 23 May 2019 05:00:00 +0000

Date Added:

May 23, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

May 23, 2019

Issue:

Volume:

380

Pages:

2020-2030

URL:

Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma.

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1901963

Keywords

asthma

randomized control trial

PMID (1):

31112386

MeSH

nebulizers and vaporizers

metered dose inhalers

In this randomized clinical trial, budesonide–formoterol (e.g. Symbacort) used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting SABA; the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. James W. Mold, MD, MPH

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BACKGROUND:

In double-blind, placebo-controlled trials, budesonide-formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β2-agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. The availability of data from clinical trials designed to better reflect clinical practice would be beneficial.

METHODS:

We conducted a 52-week, randomized, open-label, parallel-group, controlled trial involving adults with mild asthma. Patients were randomly assigned to one of three treatment groups: albuterol (100 μg, two inhalations from a pressurized metered-dose inhaler as needed for asthma symptoms) (albuterol group); budesonide (200 μg, one inhalation through a Turbuhaler twice daily) plus as-needed albuterol (budesonide maintenance group); or budesonide-formoterol (200 μg of budesonide and 6 μg of formoterol, one inhalation through a Turbuhaler as needed) (budesonide-formoterol group). Electronic monitoring of inhalers was used to measure medication use. The primary outcome was the annualized rate of asthma exacerbations.

RESULTS:

The analysis included 668 of 675 patients who underwent randomization. The annualized exacerbation rate in the budesonide-formoterol group was lower than that in the albuterol group (absolute rate, 0.195 vs. 0.400; relative rate, 0.49; 95% confidence interval [CI], 0.33 to 0.72; P<0.001) and did not differ significantly from the rate in the budesonide maintenance group (absolute rate, 0.195 in the budesonide-formoterol group vs. 0.175 in the budesonide maintenance group; relative rate, 1.12; 95% CI, 0.70 to 1.79; P = 0.65). The number of severe exacerbations was lower in the budesonide-formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 μg per day in the budesonide-formoterol group and 222±113 μg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use.

CONCLUSIONS:

In an open-label trial involving adults with mild asthma, budesonide-formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations. (Funded by AstraZeneca and the Health Research Council of New Zealand; Novel START Australian New Zealand Clinical Trials Registry number, ACTRN12615000999538.).

Author/s:

Beasley, Richard, Holliday, Mark, Reddel, Helen K., Braithwaite, Irene, Ebmeier, Stefan, Hancox, Robert J., Harrison, Tim, Houghton, Claire, Oldfield, Karen, Papi, Alberto, Pavord, Ian D., Williams, Mathew, Weatherall, Mark

Does CBD Actually Work?

Tracy Ashby — Wed, 17 Apr 2019 05:00:00 +0000

Date Added:

April 18, 2019

Journal/Publication:

Quartz

Publication Date:

April 17, 2019

URL:

Does CBD Actually Work?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

nebulizers and vaporizers

This lay press article attempts to summarize what is currently known about the efficacy of cannabidiol (CBD) for anxiety, pain, and sleep. James W. Mold, MD, MPH

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Perhaps you’ve heard a lot of people are using CBD.

The chemical compound, naturally occurring in cannabis plants, doesn’t get you high, but does have a wide swath of other purported effects making it very popular. Although clinical studies haven’t necessarily proven those results, many Americans are testing CBD (which stands for “cannabidiol”) for themselves. All over the US, people are rubbing CBD balm onto aching joints, dropping CBD tinctures under tired tongues, popping CBD gummies, and puffing on CBD oil-filled vaporizers in hopes of chilling out.

On Quartz’s behalf, Harris Poll recently surveyed more than 2,000 people in the US about their experience, knowledge, and opinions regarding CBD and found that more than 85% of Americans have heard of CBD, and of those, more than one in five have tried it.

Author/s:

Avins, Jenni

Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Tracy Ashby — Tue, 30 Oct 2018 05:00:00 +0000

Date Added:

October 30, 2018

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

John Wiley & Sons, Inc.

Publication Date:

October 6, 2018

URL:

Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta‐Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1111/jgs.15602

Keywords

chronic obstructive pulmonary disease

MeSH

pulmonary disease, chronic obstructive

nebulizers and vaporizers

asthma

This meta-analysis, focused on COPD patients, is a reminder of the importance of training patients to use their inhalers properly. That suggests that practices have at least one inhaler trainer and placebo inhalers or that patients requiring inhalers should be referred to a respiratory therapist or pharmacist for training.

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Objectives

To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD).

Design

Systematic review and meta‐analysis.

Setting and Participants

Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting.

Measurements

We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta‐analysis, clinical trials and quasi‐experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random‐effect model with Mantel–Haenszel adjustment to perform a meta‐analysis.

Results

We included 8 studies (4 randomized, 4 quasi‐experimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59–0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment.

Conclusion

All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree.

Author/s:

Maricoto, Tiago, Monteiro, Luís, Gama, Jorge M. R., Correia-de-Sousa, Jamie, Taborda-Barata, Luís